ACB Liver Case 1 - virtualpathology.leeds.ac.uk Adrian... · • Canalicular cholestasis....

Southampton Cellular Pathology

ACB Liver Case 1


Case history

• 86 year old man

• Three week history of cholestatic jaundice

• Liver screen negative

• Liver biopsy


Further investigations

• Ultrasound scan– Gallstones in gallbladder

– Common bile duct not dilated

• CT scan– Otherwise normal


Additional history

• Cut hand while gardening 4-5 weeks ago

• Cellulitis requiring IV flucloxacillin

• Jaundice developed within a few days

• Prednisolone 30mg then reducing dose

• Liver function gradually settled


Flucloxacillin reaction


Key features

• Portal tract oedema

• Mild mixed portal tract infiltrate– Some eosinophils present

• Reactive bile ductular epithelium

• Canalicular cholestasis


Patterns of drug reaction

ParacetamolNecrosis

Antineoplastic agentsVeno-occlusive disease

AllopurinolGranulomas

Nitrofurantoin, etretinateChronic hepatitis

ChlorpromazineChronic cholestasis

Contraceptive steroidsHepatic vein thrombosis

Anabolic & contraceptive steroids

Flucloxacillin, erythromycin, chlorpromazine

Cholestasis – bland

Cholestasis – cholangiolytic

Alcohol, methotrexateSteatosis


Messages

• Always consider a drug reaction

• Variety of patterns possible

• Clinical history essential– Non-prescription drugs

– Alternative medicines


ACB Liver Case 2


Clinical history

• 70 year old man

• Portal hypertension

• Large right lobe mass

• Very difficult biopsy

• ? HCC on background of ALD


Alpha-1-antitrypsin deficiency with large cell dysplasia

PiZZ phenotype


Alpha-1-antitrypsin deficiency

• PiZ and PiS are the most common deficiency alleles

• PiZ in 1-2% of Caucasians– Homozygosity [1 in 200-6000] associated with

liver and lung disease

– Disease may develop in childhood or not until adult life


Messages

• Alpha-1-antitrypsin globules may be visible on haematoxylin & eosin stain– May also sometimes only be diagnosed on IHC

• Association with liver cell dysplasia and hepatocellular carcinoma

• Hard to diagnose hepatocellular carcinoma in the absence of an expansile nodule

ACB Liver Case 1 - virtualpathology.leeds.ac.uk Adrian... · • Canalicular cholestasis....

Documents

Transcript of ACB Liver Case 1 - virtualpathology.leeds.ac.uk Adrian... · • Canalicular cholestasis....